Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

Hyun Min Ahn; Kyoung Sub Choi

doi:10.3341/JKOS.2016.57.11.1731

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Ahn and Choi: Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2016;57(11):1731-1737.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1731

Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

Hyun Min Ahn, MD^1,², Kyoung Sub Choi, MD, PhD²

¹Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Address reprint requests to Kyoung Sub Choi, MD, PhD Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0590, Fax: 82-31-900-0049 E-mail: Docchoi73@hanmail.net

Received 31 March 2016 Revised 19 August 2016 Accepted 20 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the short-term efficacy of intravitreal triamcinolone (IVTA) injection for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) refractory to intravitreal bevacizumab injections.

Methods

This retrospective, observational study included 23 eyes of 23 patients with macular edema secondary to BRVO. The patients with macular edema unresponsive to 2 or more consecutive monthly intravitreal bevacizumab injections were treated with IVTA. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before IVTA and 1 month and 3 months after IVTA injections.

Results

All patients were previously treated with 3.4 ± 1.2 intravitreal bevacizumab injections. The IVTA injection was performed at 4.3 ± 1.7 weeks after the last bevacizumab injection. The logarithm of the minimal angle of resolution (log MAR) BCVA was also decreased from 0.61 ± 0.45 to 0.52 ± 0.35 after 1 month and to 0.58 ± 0.37 after 3 months of IVTA, although without statistical significance (p = 0.114 and 0.412, respectively). Eight eyes (34.8%) showed more than 3 lines improvement of BCVA and 4 eyes (17.4%) showed stable BCVA increasing 2 lines or less. CFT was significantly improved from 512 ± 166 μ m to 310 ± 139 μ m after 1 month and to 324 ± 159 μ m after 3 months of IVTA injections (p = 0.014 and 0.031, respectively).

Conclusions

IVTA was beneficial in some patients with macular edema secondary to BRVO refractory to intravitreal bevacizumab therapy. This study indicates that IVTA could be considered as a treatment option for refractory macular edema associated with BRVO.

Keywords: Anti-vascular endothelial growth factor, Bevacizumab, Branch retinal vein occlusion, Refractory macular edema, Triamcinolone

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Figure 1.

Changes in logarithm of the minimal angle of resolution best-corrected visual acuity in eyes with macular edema secondary to retinal vein occlusion. Measurements were made at diagnosis (baseline), before intravitreal triamcinolone injection (IVTA) which is after intravitreal bevacizumab injections, 1 month after IVTA, and 3 months after IVTA. Although there was a tendency of improvement of visual acuity after IVTA, no statistical significance was found (paired t-tests).

Figure 2.

Changes in central foveal thickness in eyes with mac-ular edema secondary to retinal vein occlusion. Measurements were made at diagnosis (baseline), before intravitreal triamcinolone injection (IVTA) which is after intravitreal bevacizumab injections, 1 month after IVTA, and 3 months after IVTA. The central foveal thickness was significantly improved after IVTA (paired t-tests).

Figure 3.

Spectral-domain optical coherence tomography images of an eye diagnosed with refractory macular edema secondary to branch retinal vein occlusion. Compared to baseline (A), macular edema showed no definite change after 4 consecutive monthly intravitreal bevacizumab injections (B). A marked decrease in macular edema and improved visual acuity (from 20/200 to 20/25) was noted 1 month after an intravitreal injection of triamcinolone (C).

Table 1.

Baseline clinical characteristics of patients with retinal vein occlusion

	Data
Age (years)	58.6 ± 8.4 (41–78)
Gender (n, %)
Male	10 (43.5)
Female	13 (56.5)
Classification (n, %)
Non-ischemic type	16 (69.6)
Ischemic type	7 (30.4)
Baseline BCVA (log MAR)	0.65 ± 0.41
	(range CF-20/30)
Mean baseline CFT (μ m)^*	562 ± 156
	(range 322–798)
BCVA (log MAR) before IVTA	0.61 ± 0.45
	(range CF-20/30)
Mean baseline CFT (μ m) before IVTA^†	512 ± 166
	(range 302–772)
Number of bevacizumab injections	3.4 ± 1.2 (3–5)
before IVTA
Lens status (n, %)
Phakia	17 (73.9)
Pseudophakia	6 (26.1)
Macular edema type (n, %)
Combined with SRD	12 (52.2)
Without SRD component	11 (47.8)

Values are presented as mean ± SD (range) or n (%) unless other-wise indicated. BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; CF = counting finger; CFT = central foveal thickness; IVTA = intravitreal triamcinolone injection; SRD = sensory retinal detachment; SD = standard deviation.

^* Mean baseline CFT ± SD (μ m) before intravitreal bevacizumab injection

^† Mean baseline CFT ± SD (μ m) between intravitreal bevacizumab injection and IVTA.

Table 2.

Comparisons between triamcinolone response group and non-response group

	Response group (n = 12)	Non-response group (n = 1	1) p-value
Age	61.6 ± 8.1	57.3 ± 6.4	0.672^*
Classification (n, %)
Perfused type	9 (75.0)	7 (63.6)	0.554^†
Ischemic type	3 (25.0)	4 (36.4)
Lens status (n, %)
Phakia	8 (66.7)	7 (63.6)	0.882^†
Pseudophakia	4 (33.3)	4 (36.4)
Baseline BCVA (log MAR) (Snellen equivalent)	0.60 ± 0.49	0.63 ± 0.33	0.672^*
Baseline central macular thickness (μ m)	498 ± 191	533 ± 186	0.125^*
Time from baseline to triamcinolone injection (months)	4.2 ± 1.2	4.4 ± 1.8	0.912^*
Macular edema type
With SRD	8	4	0.115^†
Without SRD	4	7

Values are presented as mean ± SD or n (%) unless otherwise indicated. BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; SRD = sensory retinal detachment.

^* p-value by t-tests

^† p-value by Fisher's exact test.

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